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The following articles have the tag PSR
A GP’s legal victory when a court ruled the appointment of a Professional Services Review panel was wrong could be questioned, with a judge clearing the Commonwealth to appeal the decision before the full bench of the High Court.
AT LEAST 60 medical centres, each with multiple doctors approaching inappropriate levels of MBS billing, are in the federal government’s sights as part of a Medicare crackdown on over-servicing.
THE Medical Board of Australia (MBA) says it will “consider the implications”, after a GP who congratulated a patient for refusing to vaccinate her child avoided disciplining by a tribunal - despite the MBA’s push for a finding of incompetency.
MEDICAL Journal of Australia publisher AMPCo has ended weeks of speculation around former MJA editor Dr Annette Katelaris, admitting that “differences” between Dr Katelaris and the board led to her departure.
PRESSURE is mounting on the AMA to explain the departure of former Medical Journal of Australia editor Dr Annette Katelaris after a prestigious international editors’ group tabled the issue at a recent meeting in New York and expressed concern about the journal’s reputation.
THE Professional Services Review (PSR) is expected to resume full operations within the next three months, following an 18-month shutdown triggered by revelations panel members had not been correctly appointed.
A campaign is soon to be launched calling for an overhaul of the PSR system and establishment of a new “independent professional body” to develop clinical protocols GPs can refer to when interpreting MBS item descriptors.
Four NSW GPs who successfully challenged PSR orders to repay tens of thousands in Medicare claims now face the prospect of being referred back before the review, more than a decade after the original orders were made.
Laws to retrospectively validate past PSR findings, extend the scope of the review to all MBS-claiming practitioners and “automatically” deem any breach of the 80-20 rule inappropriate practice were introduced to federal parliament this morning.
Laws to retrospectively validate past PSR findings, extend the scope of the review to all MBS-claiming practitioners and “automatically” deem any breach of the 80-20 rule inappropriate practice have been introduced to parliament this morning.
AN INQUIRY was due to have commenced this week into proposed legislation that would allow dentists to keep incorrectly billed Medicare payments and exempt them from investigation by the Professional Services Review.
GPs concerned about attracting the ire of Medicare and the PSR by incorrectly interpreting MBS item descriptors will be able to rely on a recently unveiled advice service.
EXPERTS are divided over the prospect of the Professional Services Review (PSR) being given power to target corporate practices suspected of “coercing” GPs into inappropriate MBS claims, after the federal government agreed to consider lengthening the watchdog’s leash.
GPs could be banned from prescribing specific drugs on the PBS, while PSR panels could include legally qualified representatives, after the federal government accepted all recommendations arising from last year’s senate inquiry into the Medicare watchdog.
PLANS to write laws to retrospectively validate the appointment of PSR panel members have been revealed, as the government last week won the right to appeal last year’s judgment against the Medicare watchdog by GPs in the Federal Court.
After six years as PSR director, Dr Tony Webber remains determined to eradicate Medicare abuse.
THE High Court has granted leave for the government to appeal last year’s Federal Court decision that invalidated PSR findings against four GPs.
GPs, ophthalmologists and obstetricians have reacted angrily to being made examples of in an article by former Professional Services Review (PSR) director Dr Tony Webber, who claimed the Australian health system is leaking up to $3 billion annually.
FORMER PSR director Dr Tony Webber has claimed he was gagged by the health department when he raised concerns that hospitals were “cost-shifting” by pressuring GPs to order preoperative tests through Medicare.
CLAIMS that GPs or doctors’ groups could pay a levy to help run the Professional Services Review (PSR) have been rejected by experts who say the suggestion is out of date and probably never intended to be made public.
THE NSW Health Care Complaints Commission (HCCC) has been forced to scrap its standard practice of giving every complaint recipient the chance to respond as it struggles with a sharp rise in notifications despite falling staff numbers.
FORMER AMA secretary general and GPET CEO Dr Bill Coote has been appointed permanent director of the Professional Services Review (PSR) and will begin his three-year appointment on 14 November.
FORMER Professional Services Review (PSR) director Dr Tony Webber has welcomed a recommendation that the review be given the powers to “effectively pursue” corporate abuse of the MBS or PBS system so contracted GPs are not left “carrying the can”. The recommendation was one of seven contained in a Senate Community Affairs References Committee inquiry report into the PSR released today. The report comes as the government continues its efforts to challenge a Federal Court decision earlier this year that found a number of PSR rulings to be invalid. The ...
FORMER Professional Services Review (PSR) director Dr Tony Webber has told a Senate inquiry the watchdog’s powers should be expanded so it can take on corporate practices. While appearing before the inquiry into the processes of PSR committees yesterday, Dr Webber told senators the “corporatisation of medicine” had changed it forever, while Medicare still operated on the “honour system” and legislation had struggled to keep pace. “No other system allows the recipient of commonwealth funds to determine the level of their remuneration,” he said. “[The legislation] has come to ...
Lamenting the loss of a ‘folk hero’ who died, finally vindicated...
DOCTORS feel they are being victimised by Medicare and the PSR process, which fails to take account of the complexities of general practice, a Senate inquiry has been told. The claims were made in submissions to the inquiry into the operations of the PSR from medical indemnity organisations Avant, MDA National and the Medical Indemnity Protection Society (MIPS). All raised concerns that GPs felt singled out by the PSR process and have called on the government to overhaul MBS compliance measures. MIPS, in its submission, said many GPs continued to hold a view that the “Medicare ...
THE embattled Professional Services Review (PSR) has a new acting director, with the appointment of former AMA secretary general Dr Bill Coote replacing outgoing PSR boss Dr Tony Webber, who is due to step down at the end of the week. Health Minister Nicola Roxon today officially announced the appointment of Dr Coote who will serve as acting director for the next three months while cabinet considers a permenant appointment. The appointment of Dr Coote, who was also previously foundation CEO of General Practice Education and Training (GPET), comes amid ...
LAWYERS involved in a Federal Court win over the Professional Services Review (PSR) have been swamped with calls from GPs forced to pay back money to Medicare as the blame game continues over the bureaucratic failure that could invalidate a decade of committee findings.
THE Medicare compliance process has been thrown into disarray, following a landmark Federal Court decision that has found PSR rulings from 2005 onwards to be invalid. The court found in favour of a group of four GPs who had challenged PSR findings against them, judging the watchdog’s rulings were not legally valid on the grounds that some of its panel members were improperly appointed. Under the Health Insurance Act 1973, appointments to these panels must be done so in consultation with the AMA. This had not happened since 2005. It is was unknown ...
THE psychological stressors affecting GPs appearing before the Professional Services Review (PSR) committees will be the subject of a landmark study. The study comes as a Senate Community Affairs Committee prepares to announce the first public hearings for its inquiry into the appropriateness of the PSR process. Monash University adjunct associate professor Felicity Allen will lead the research, which is set to begin with a pilot study involving a small group of GPs who have been through the committee process. The pilot will then be used to inform a larger study with more participants later in ...
A GROUP of GPs dissatisfied with their treatment at the hands of the Professional Services Review (PSR) have succeeded in their quest to initiate a parliamentary inquiry into its operation and outcomes. WA Coalition Senator Chris Back successfully moved yesterday to refer the matter to the Community Affairs References Committee, which will hold a wide-ranging inquiry and report back by 22 September. The news came as the PSR prepared to release a guide for practitioners called before a committee or selected for a Medicare review. The PSR has faced significant criticism since it was revealed last ...
PROFESSIONAL Services Review (PSR) director Dr Tony Webber has backed down on a promise to publish the annual Report to the Professions this year and will instead add information on specific cases to its annual report. The news follows earlier calls from the AMA for the information in the report to be disseminated in a more constructive way. AMA president Dr Steve Hambleton previously argued that while information gathered by PSR committees could be valuable to practitioners, it could be better disseminated to doctors, possibly via the colleges and professional bodies to both members and non-members. ...
SENIOR GPs are being urged to make themselves available to serve on Professional Services Review (PSR) committees when applications open later this year. AMA president Dr Steve Hambleton said the input of senior doctors would help rebuild the profession’s confidence in the process following the forced resignations of all panellists late last year amid revelations that they had not been appointed in line with required protocols. The resignations subsequently led to all 39 cases before the PSR at the time being dropped. “We want to make sure we have the right people on the committees so ...
GPs are set to come under additional scrutiny from Medicare with those who have referred patients to the Chronic Disease Dental Scheme now in the spotlight after investigations found 59% of dentists audited over their use of the scheme had bent the rules. The findings prompted Human Services Minister Tanya Plibersek to announce the investigations would be dramatically expanded to another 400 dentists and the GPs who made the referrals. The latest crackdown follows the recent announcement that Medicare was to begin targeting GP prescribing of narcotics after the Minister cited a significant rise in the levels ...
NEW data revealing the continuing rise in GP management of chronic disease has sparked fresh calls for better remuneration of complex care. The latest General Practice Activity in Australia 2008-09 (BEACH) report has shown that chronic conditions management constitutes over a third of GPs’ workload with more cases being diagnosed and treated, despite fewer hours being worked. The report published this week by the AIHW based on almost 100,000 consultations carried out by almost 1000 GPs, has also shown the number of GPs working more than 40 hours per week has plummeted from 43% in ...
MEDICARE watchdog the Professional Services Review (PSR) has suspended all operations of its peer review committees following revelations of irregularities in the appointment of panel members. A spokesperson for the PSR has confirmed that 40 matters before the PSR had been deferred after every panellist – understood to be almost 100 – was asked to resign and apply for reappointment. The move follows news that the Department of Health had failed to seek the necessary AMA approval for the appointment of an unknown number of panellists, as required by the legislation governing the PSR’s operations. “The ...
MEDICARE watchdog the Professional Services Review (PSR) has been forced to seek the resignation of all of its medical practitioner panellists following revelations regarding irregularities in their appointments. AMA vice-president Dr Steve Hambleton has confirmed that many pending cases before the PSR had been put on hold after every panellist was asked to resign and reapply for their position. However, he questioned News Limited reports indicating the PSR’s work had been “suspended”. The move follows revelations that the Department of Health had failed to seek the necessary AMA approval for the appointment of an unknown number of ...
GPs forced to front the Professional Services Review (PSR) may soon find it a less confusing and frustrating prospect, with a fresh review set to improve the transparency and accountability of the peer review process. At a recent meeting with the AMA, PSR officials agreed to review, and improve, its processes and functions so GPs would have a clearer idea of what to expect when called on to explain their billing. AMA vice-president Dr Steve Hambleton told MO that while he supported the role of the PSR, GPs deserved greater assurance that its processes were fair and ...
GPs forced to front the Professional Services Review (PSR) may soon find it a less confusing and frustrating prospect, with a fresh review set to improve the transparency and accountability of the peer review process. At a recent meeting with the AMA, PSR officials agreed to review, and improve, its processes and functions so GPs would have a clearer idea of what to expect when called on to explain their billing. AMA vice-president Dr Steve Hambleton told MO that while he supported the role of the PSR, GPs deserved greater assurance that its processes were fair and ...
A GP has been forced to repay Medicare $473,000 after he fell foul of the Professional Services Review (PSR) for over-servicing and excessive ordering of pathology requests. The doctor was one of 49 medical professionals required to enter a negotiated agreement with the PSR in the last year after their practice was found wanting. According to the PSR annual report excessive pathology requests are continuing to land GPs in front of Medicare’s watchdog, and doctors are now being urged to give greater consideration to which tests they order for patients. Writing in the annual report, director ...
A GOVERNMENT proposal to restrict the ordering of tests for certain vitamin levels has met with opposition from doctors, who warn such a move could prove a risk to patient health. The Australian Association of Pathology Practices (AAPP) fears that requests for vitamin D, B12, iron and folate tests have been earmarked for cost-cutting under the ongoing Medical Benefits Reviews Task Group, which has been charged with finding economies within the MBS. At recent meetings of the Pathology Review Consultation Committee, which reports to the task group, the Federal Health Department flagged a sharp rise in vitamin ...
ONGOING abandonment of long consultations in general practice may stymie the Federal Government’s preventive heath agenda, experts say, in spite of nurses taking on a greater role in general practice. Research from La Trobe University, published in the MJA, suggested that recent attempts by the Government to simplify the MBS were unlikely to encourage GPs to embrace long consult items they began to shun two years ago.Using MBS data, researchers confirmed a significant drop in Level C and D consultations. They showed that until 2007, long consultations had been steadily climbing for many years, however in that ...
Can you identify a doctor shopper? And what are your obligations when it comes to prescribing drugs of addiction? Caroline Brettingham-Moore asks the experts.
GPs have been warned not to be pressured into writing team care plans for ineligible patients, with the Professional Services Review (PSR) citing a rise in unjustifiable claims. While also indicating a rise in inappropriate prescribing of narcotics and benzodiazepines, the annual report of the profession’s watchdog highlighted a trend of GPs writing care plans for patients for conditions that fall outside the team care item descriptor. Item 723 stipulates that patients must have an existing chronic or terminal medical condition requiring ongoing care from a multidisciplinary team of their GP and at least two other health ...
S4 and S8 drugs – Mary Fallon reports on how to avoid trouble with the PSR. THE Professional Services Review (PSR) caseload has more than doubled every year since 2006, numbering more than 120 cases in 2008-09, and GPs make up most of the Medicare-initiated referrals. Many investigations were generated by unusual prescribing patterns, especially in relation to narcotic analgesics, antibiotics and benzodiazepines, PSR director Dr Tony Webber said in the organisation’s 2007-2008 annual report. There are strict regulations surrounding the prescription and supply of S4 prescription-only medicines and S8 controlled drugs. Doctors may ...
DOCTORS will have a direct role in influencing regulations that will underpin the “risky” legislation to grant nurse practitioners and midwives access to the MBS and PBS by the end of 2010. Speaking at a National Press Club address in Canberra last week, AMA president Dr Andrew Pesce said the association had been invited by the Prime Minister’s office to advise on implementation of the controversial measures. Despite welcoming the involvement, Dr Pesce reiterated past criticisms of the legislation – which is now before Parliament – saying it was not the answer to ongoing health workforce shortages. ...
GPs have renewed calls for specialists to be brought under the same level of scrutiny as general practice through fairer targeting of Medicare audits across the health professions. AMA council of general practice chair Dr Rod Pearce said despite Medicare’s efforts to introduce such parity, GPs were still disproportionately audited and subsequently referred to the Professional Services Review (PSR). A 2007 review of the PSR found that fewer than 5% of all practitioners referred to the body between 1999 and 2007 were specialists ( MO , 5 October 2007 ), despite the fact that they accounted ...
Clinical notes can help you in court and with the Professional Services Review, but records aren’t always up to scratch, as Mandy Bryan discovers in the second of this two-part series. IT’S common knowledge: having good medical records is good clinical practice and can make or break your defence. But at least 80% of those GPs fined thousands of dollars for inappropriate practice in the year to June 2008 were caught short here, according to the Professional Services Review (PSR). Though there were other factors at play in these cases, records were still a ...
The latest PSR report identifies four main areas where GPs slip up. Mandy Bryan reports on the common mistakes in the first of this two-part series. WHEN Cairns-based general practitioner Dr M prescribed high levels of narcotics but failed to document the rationale and proposed management of patients on this long-term therapy, he paid a hefty price. Medicare benefit repayments worth $188,256 and full disqualification for six months were among the penalties, and he was also referred to the Medical Board of Queensland for further investigation. GP Dr J of Sydney was also found ...
GPs are about to face even more scrutiny from the Professional Services Review (PSR), with the body now predicting it will quadruple the annual number of doctors targeted. The revelation comes with the release of the PSR’s annual Report to the Professions . Fifty cases were reviewed in 2007-08 – nearly double the number reviewed the previous financial year – and this is expected to double again on the back of ramped-up Medicare audits. PSR director Dr Tony Webber told MO that during this financial year, the body had already been asked to examine ...
DOCTORS have backed calls from the Professional Services Review (PSR) to consider harsher penalties for practitioners who repeatedly claim inappropriate MBS rebates. The PSR annual report revealed that nearly 40% of those who fronted the body in the last year had previously faced peer scrutiny, prompting director Dr Tony Webber to question the adequacy of existing sanctions. The report also showed that more than half the cases finalised in the previous year involved investigations of rebate claiming for Level C and D consults. The news comes ahead of the planned 400% increase in the number of Medicare ...
THE federal government has softened its hard stance on Medicare claims for Level C and D consultation billing, issuing a new clarification to allay widespread GP anxiety. But questions have been raised as to whether the new advice – drafted in consultation with the AMA – will actually reassure practitioners. A furore erupted earlier this year when Medicare watchdog the Professional Services Review (PSR), in its annual Report to the Professions , warned GPs against billing for longer consultations for patients presenting with multiple unrelated ailments, even if they took longer than 20 minutes ...
PSR director Dr Tony Webber’s suggestions to practitioners confronted with a patient with a “string of unrelated ailments” call for discussion. He says, “Raise your private fee” (i.e., don’t bulk-bill). Or he suggests telling patients that if they want more than one problem dealt with today, Medicare won’t pay, but come back another day and Medicare will pay. I’m sure Dr Webber is aware that if the patients choose to come back another day, it will ultimately cost Medicare more money for three Level B consults than one Level D, also wasting time. I suspect it will also ...